This article has grown out two different sources; a discussion which has developed during transmitting the Engaging Vitality approach to an audience with a Toyohari background and an article by Chace and Rodriguez Cuadras on propensity which was published recently in the Lantern, I was requested to elaborate on my thoughts about the issues discussed there and this article is the result.
As a practitioner of Toyohari and related styles as well as a practitioner of the Engaging Vitality approach I have been pondering about bridging the differences and utilizing the common features.
Engaging Vitality has grown out of an integration of different approaches in East Asian Medicine, Osteopathy, the wider environment of Classical Chinese philosophical literature and the Nei Dan (inner cultivation) tradition. It has been developed by Dan Bensky and Charles Chace and Margueritte Dinkins.
It puts a lot of emphasis on palpation techniques. Engaging Vitality learns us also to integrate physical anatomy with acupuncture’s energetic anatomy.
Toyohari is a form of meridian acupuncture which has been developed in the last century by blind practitioners in Japan. It puts a lot of emphasis on palpation, especially abdomen and pulse diagnosis. The interpretation of Five Phase theory according to the classical literature is an important element in the treatment strategy. Another important feature of Toyohari is contact needling, a technique of non insertive needling. Needles are thus not inserted or only very superficially.
It is my opinion that both approaches can benefit from each other. And ultimately all acupuncturists could benefit from both styles. In regard to palpation skills and needle techniques meridian therapists, especially Toyohari practitioners have developed a very refined approach which definitely can serve practitioners from other styles of acupuncture. Engaging Vitality gives practitioners another set of palpatory markers that can benefit meridian therapists and other practitioners as well. Another advantage of the Engaging Vitality approach is the letting go of protocols, although initially a protocol is taught, it learns practitioners to follow the inherent treatment plan of the patient. It is in this respect also that the topics discussed below play an important role.
I believe that we all can benefit from each other and in this way can develop East Asian Medicine.
In a recent publication in the Lantern, Efficacy Born of Disposition (Shi 勢), A Broad Perspective on Treatment Strategy in Acupuncture Therapy by Charles Chace and Manuel Rodriguez Cuadras , there is a discussion on the role of propensity in East Asian medicine. The authors focus on the concept of sho(證)and the role of yi(意)in the process of diagnoses and treatment. I hope my contribution can shed some more light on the ambiguities in this discussion. I will especially discuss the two mentioned concepts of yi and sho.
For a more thorough discussion about this subject I would like to refer to the article mentioned above. In regards to the concept of Propensity in China, I would also like to refer to Francois Julien’s book, The Propensity of Things. I just would like to highlight some of the points which are discussed in the article of Chace and Rodriguez, and to shed light on these with my own ideas and experiences. I hope it can help out Engaging Vitality and Toyohari practitioners as well in reflecting on these important concepts.
Yi in relation to Shi
The capacity to listen is of vital importance of understanding the shi(勢), the propensity or terrain. Like the scouts of an army would inspect the terrain, we as practitioners have to inspect the terrain of our patients. We can do that with all our senses, like we have learned in Oriental medicine, whether we use our smell, ears, eyes, or our touch. We also listen to the propensity by means of our yi , (意) with both our intention and most importantly our attention, which allows us to remain optimally open to the information we receive.
Yi is thus an important aspect which can be interpreted at different levels.
In the light of listening to propensity, Chace and Rodriguez Cuadras, elaborate on the concept of yi by interpreting it at two different levels; intention and attention. Giving leverage to the last over the first interpretation. Although attention is definitely a stage higher and is vital in listening to the propensity, we could take even a step further.
In the Zhuangzi there is beautiful story about the instructions of Master Kong (Confucius) to his disciple Yan Hui.
Make your will one! Don’t listen with your ears, listen with your mind (心). No, don’t listen with your mind, but listen with your vital energy (氣). Listening stops with the ears, the mind stops with recognition, but vital energy is empty and waits on all things. The Dao gathers in emptiness alone. Emptiness is the fasting of the mind.
Master Kong’s advise can be interpreted as an instruction about yi. It can be translated variously as thought, intention, attention, wish, idea, imagery, intellect. It could be also translated as awareness. Stephen Birch’s insightful reading of the above passage interprets yi at three different levels. The first level is intention (listening with the ears), at this stage one needs still effort, the second level is attention ( listening with the mind/heart), this is less at a physical level, but more mental, still there is the danger of forcing, hence the warning in the Daodejing : “If the heart directs the Qi, this is called: forcing”
The third level (listening with the vital energy) is a much more effortless way, and can be explained as awareness. This level can only be reached after intensive practice. It is of course this ultimate level which one should strive for, this is the level of the Superior Physician.
At the first level one is learning and practicing, one needs an intention for something to happen. At the second level, things are going more smoothly. By bringing our attention to the process, we can be able to discern all the patterns and movements of qi, and are able to initiate a process with our attention. Or even better said, we create the space for things to happen. At the third level one simply acts and performs naturally, this is the stage of Wu Wei (無爲) “effortless action”. In a state of integrated awareness we are able to operate at an optimal level.
These stages could be applied to other disciplines as well, we see the same approach in martial arts, calligraphy, archery and self cultivation.
One could say that in the beginning one needs intention, since one’s skills are not yet developed. In a further stage of training one is able to work more from one’s attention and only after a long time of training when one’s skills are internalized one can forget about all that, and just be aware. There are some nice stories in the Zhuangzi which illustrate that process of development, examples are the story of Cook Ding , the Bell maker and the Swimmer.
All these stories illustrate very well the obtaining of the knack. If one is able to master a skill and “forget” about it, the performance becomes natural and effortless.
This form of obtaining skills and forgetting our common knowledge is a red thread in the Zhuangzi and is also central in the practice of acupuncture.
What I have understood personally about yi, is that in the case of intention, we want the qi to move in a certain direction, to have it undertake certain actions etc. This form of intention is important when we start practicing acupuncture. But even when we are skilled practitioners, we still might like to direct qi in one way or another at a certain moment.
The second form is attention in which we are focused and are able to listen to all the subtle processes of qi, we listen to the story of the qi. This is a much more receptive state.
We might make a subdivision here, in the first instance we are focusing maybe in a more narrow sense, like we are taught in Toyohari to focus on the tip of the needle when we do the needling. On a second level however, we can elevate this attention to a much wider scope, where we are truly listening with all our senses and are able to become aware of all the subtle processes. In this way we can profoundly scan the propensity. This form of yi is already much more natural but there remains still a mental focus.
This is the listening as I understand it in the presentation of Chace and Rodriguez Cuadras. In a way this might already approach the highest stage, that of awareness, referred to by Stephen Birch .
That third stage, awareness, might however be even a stage further, a non dualistic state. In the Zhuangzi it is said that “Emptiness is the fasting of the mind”. So at this level we have surpassed all dualistic perceptions and we are simply “aware”. It is a state where the practitioner doesn’t put any effort. All manifestations of qi are perceived in a natural way and the practitioner just anticipates the qi like a dancer would follow his/her partner. This is a stage where we are able to integrate the listening of all manifestations of qi of our patient, with all the inner dynamic processes in ourselves and the surrounding environment, the cosmos. At the same time being aware about all the interactions between these three. This might be the ultimate stage of the Superior Physician, a level which we ideally would like to obtain but won’t be easy in our daily clinical experience. If we are already able to really listen in the sense of attention instead of intention we could be quite happy.
The Taiwanese Scholar Rur Bin Yang gives in this light an illuminating view on this passage of the Zhuangzi. In his interpretation , the listening with Qi is a radical unification with the Qi in which we pass all duality and our perception also changes radically. He talks about Synthesia, in which all our sensory perceptions blur , an effect we see in some mystical states and psychedelic experiences. 2
When we are able to listen with our “mind” or even better with our “vital qi” we will gather so much more information. This will enable us also to follow the inherent treatment plan of our patient. Instead of following a fixed protocol and a selection of treatment points and techniques, we will naturally arrive at every stage. So at every stage of our treatment, the treatment plan will unfold itself, whichever meridians and points will make themselves available to us at a certain moment and we can anticipate effortlessly to what unfolds itself .
Ultimately I think these different forms and aspects of yi are not separate either, they all serve a certain purpose and are interwoven. Also it is my belief that these things might shift from time to time. Maybe at a certain moment we need a certain intention to get things moving, another time we just can quietly wait and listen and follow the listening and sometimes even in an enlightened flash we might be spontaneously able to transcend our dualistic perception and be in a state of awareness, being able to integrate the listening into a non dual state. For myself, what is most important is our capacity to listen in a state of stillness and awareness, this is the basis for optimal practice as I understand it myself.
This discussion about listening brings us to another vital element in our practice, the concept of sho or zheng, since this can grant us insight in the nature of propensity , the shi (勢)
Shi in relation to Sho
Sho (or Akashi) is the Japanese word for 證 zheng (in Chinese) This concept plays an important role in Meridian therapy and its offshoots like Toyohari. Sho could be translated and interpreted differently. We could translate this as the present condition or conformation of the patient. Another interpretation could be the constitutional pattern. So we can speak actually of different sho’s constitutional and actual presentation.
In Kampo medicine sho is also used as a conformation build on different diagnostic parameters, often a herbal formula is attached to a whole conformation as a “sho”.
Chace and Rodriguez Cuadras translate sho as ” the reflection of the ground, the lay of the energetic land that defines the context in which we will work”, the terrain which we as therapists enter and need to gain intelligence about before we engage and also during our engagement. Or as an entry point for the conversation with the qi of our patient.
In Toyohari the right sho is mainly determined by the hara (belly) and the pulse, although other parameters like the meridian zones, colors of skin, smell etc. are also used as secondary sources. The sho is neither a fixed state, a sho can change and after a series of successful treatments the constitutional sho might (re)appear. In Toyohari there is a limited amount of possible sho/patterns, though it is crucial to select the correct one if the treatment is to be effective. The sho is treated by selecting the right sho, this is cardinal in Toyohari treatment. In Toyohari there is a limited amount of possible sho/patterns. Treating the sho by selecting points according to the engendering and controlling cycles is considered a root treatment and as such the most important part of the treatment. Some great masters in Japan can perform almost miracles by just selecting a few points and treat them with contact needling (non insertive needling).
Chace and Rodriguez Cuadras rightly question whether just treating the sho is really a root treatment and if it is that sufficient or if it is rather a beginning of the conservation with the qi of the patient. Also they question if treating a sho initially is always the proper way of engagement, since a move in the periphery might be more optimal in certain conditions.
Maybe our concept of sho and root treatment should be altered.
We could think of it differently in more than one way. First of all we could extend the concept of sho to the whole territory of engagement, in that sense even the periphery is part of the sho.
My own understanding of sho is larger than the definition of sho in the traditional Toyohari setting. The Toyohari concept of the sho might be narrowed down to the selection of a relatively small range of involved meridians and points, but at the same time it gives a bigger picture of a whole terrain with all its different features like texture of skin, colors, sounds, smells, appearance of dampness or dryness, differences in temperature, meridian and Hara features and pulses. So this is a rich mélange of information about the terrain or the propensity. At the same time we could integrate information from other palpatory markers , like the ones we use in Engaging Vitality. If we look to sho from that perspective we can gather a great amount of information and it can help us definitely in getting an image of the overall propensity.
Toyohari practitioners argue that treating the right sho is the root of a treatment. If one is able to facilitate a profound shift that may initiate the self reorganizing ability of the body, then such an intervention is indeed that basis or foundation of each treatment. Yet I agree with Chace and Rodriguez Cuadras scepticism that such a shift will happen by just treating the sho as the first step in any treatment. In their article they argue that often an initial opening in the periphery is more effective than a frontal attack (in military terms).
My own experience is that both can happen . Of course, sometimes it so obvious, the system asks you to go and you go straight for it, like the frontal attack. But definitely there are many instances in which a circumventing move is much more effective as the first step to get into conversation with the system.
Although treating the sho in a more narrow sense is not always the best first movement, and the effects are not always so profound as we expect them to be, treating a sho has the ability to settle the system. I have found myself now quite often doing a sho “root” treatment in an initial stage, but I think it is more an introduction than a root treatment. The system settles and things got more clear, other palpatory markers become more clear. This makes it more easy for me to gather more information which will help me in assessing the next steps to take. At the same time the system is more settled and this will be helpful in all we do next.
We also see this during Engaging Vitality training sessions, students learn an exercise in which they are asked to pick out the most obvious pulses and treat relevant points . This is quite similar to the treatment of a sho (root treatment), but most importantly it just helps the system to settle, supple, open and integrate. Things get more clear and we are more able to feel the different manifestations of Yang and Yin qi , the fluid body etc. In other words it is just the beginning of the conversation.
On the other hand I have seen instances in which such a root treatment causes a profound shift, especially when it is done by a great master. Treatments from Yanagista sensei come to my mind in this instance, just one or two points can do the job. But of course in how many instances does that happen? There is no absolute truth here.
My own experience is that this applies to other so called “root” treatments as well. For instance, I also use Manaka3 style in my practice , but once again ,when administered as an initial stage (the root treatment is picking master couple points of the Extraordinary Vessels and connect them with ion pumping cords), In some instances I find it more settling to the system than a meridian style root treatment. If you pick the right pair (and those should be really present in a presentation) it can have a great settling effect and will show also in many palpatory markers.
Although this definitely has a settling effect, it is my experience that if one wishes to address the Extraordinary Vessels , it is often not the first thing one wants to do in a treatment. In many cases a more circumventing move , finding an access point in the periphery, will be more effective initially.
As said before, one doesn’t intent to do a specific thing like an extraordinary vessel treatment, but just addresses it when it unfolds itself.
Also I have come to believe that there are more profound ways to engage with the Extraordinary Vessels, than only needling master couple points. One can even question how much we are really targeting the Extraordinary Vessels with just needling master couple points. An interesting approach to extraordinary vessels is practiced in Engaging Vitality which is based on Li Shizhen who combined acupuncture and Neidan approaches.
I am not downplaying other approaches like master couple points, I use them quite often , but at times other points are more available and are far more effective.
Still the Manaka root treatment has that initial settling effect, which can in times be very useful. It is amazing to see how drastically the changes often are on the hara as well its effect on other palpatory markers.
The Engaging Vitality approach places a lot of emphasis on opening restrictions and there is the idea that if we are able to open a restriction initially we will enhance the process of settling, suppling , integrating and opening. In my own experience this approach is very valuable and opening the system up might be even more important than supplementation, dispersion or harmonizing. Chace and Rodriguez Cuadras argue that opening (tong 通) will often precede supplementation. I think there is definitely some truth in that, and often an initial opening will also have a reinforcing effect. This brings us to the question what really happens when we supplement or disperse.
I have been playing around with these concepts in my own clinical practice. I have seen that all different techniques had a qi flow enhancing effect. Whatever I did , as long as it matched the way the qi was unfolding itself , ultimately the system opened up. So maybe supplementing, dispersing or harmonizing techniques have ultimately an opening effect. In the end we intend to improve the flow of qi, whatever we do in a treatment.
So even if we start a treatment with supplementing it might actually open the system, and when we are intending to open the system we might actually supplement, drain or harmonize qi. At the same time it might all depend on our intention. So once again here comes the concept of yi in to play. We can ask ourselves what happens if we intend to open or supplement or whatever.
Another approach would be that we needle with attention or awareness. In that case we just let happen what needs to happen. My own experience is, that if I needle and just remain with the needle, just connecting with the qi, a process will evolve. I might see an opening of the system and at the same time I might see that vacuity is reinforced or excess is being drained naturally. There is no space here to go deeper into these questions, but it might be interesting to reflect further on this issue.
At least we have to remain open minded, we really need to be aware what the propensity is telling us. We need to see what is the most appropriate to do in the actual setting. So instead of clinging to a fixed strategy or protocol, we should always try to act in accordance with the conditions.
I think that one could come up with other strategies as well, there are many things we could do to initially settle the system and to open it up. Also our own state plays an important role as well.
As has been previously stated, the yi plays here a cardinal role. So we need to bring ourselves in a state of settling, suppling, integrating and opening. If we are in that state, our patient will also shift far more easily into that state. So our own state might be as important as all other things we do during a treatment.
In my own experience I have come to realize about the great importance of our own state in all procedures during listening and needling. Of course it is very important to master all the needling techniques, but these will lack their full potentiality if our state is not open and aware.
So my own experiences regarding “root treatment” suggest that they can play a role in settling the system initially , that it can be a starting point to engage our conversation with the qi of our patient and that in some instances it is doing much more and can generate a profound shift, but we shouldn’t take it for granted. At other times we need other initial approaches, just depending on what the system is telling us.
Ultimately things are not that clear cut and there is no ultimate truth in how we have to engage the terrain of our patients. Every sho is fluid , they aren’t fixed patterns and there are no fixed rules for engagement. Every time and condition will require different strategies. It all comes down to an optimal way of listening. If we are able to listen to the qi of the patient, be able to observe the terrain or propensity correctly, we will also be able to find the most optimal way of engaging with the system at that given moment. This rule we can apply in other fields as well, whether we are doing Taijiquan or Aikido , waging a battle or crossing a stream. For everything we need the right time, right place and the right means.
Also considering the treatment of a sho and how we are able to establish the view that we have succeeded in a treatment, we need to take a broader view in consideration. In Toyohari the focus is primarily on the pulse and secondary on the hara. Of course we want to see good changes in pulse and hara, but not always are these signs reflecting the real nature of change that has taken place. I think it would be wise to consider here once more the wider interpretation of the sho. Again, Chace and Rodriguez Cuadras question the reliability of pulse changes alone as a measure of therapeutic change. Of course we should consider all the subtle signs of the body, whether it is smell, colour or texture of the skin, breathing, meridian zones or pulse and hara findings. At the same time it is useful to integrate some of the other palpatory markers used in the Engaging Vitality approach. For instance in addition to positive pulse changes we should see improvements in the Shape of the Qi, Yang Rhythm (CRI in Osteopathy), Yin Rhythm (Mid or Fluid Tide in Osteopathy), the Fluid Body and other markers. Positive changes in the majority of these markers increases our confidence that our treatment has achieved a desired effect. These markers also provide immediate feedback, if we are doing too much and over treating the patient. Taken as a whole this approach provides a much broader context for observing the sho.
It is my belief that we could benefit greatly by reflecting on the meaning of propensity in the context of acupuncture. If we are able to really listen with an open state of awareness, we will be able to use optimally all information which is available.
I also think that we are at an interesting point in the development of East Asian Medicine. We are able to integrate aspects from different approaches in East Asian Medicine and ultimately develop our own approach. If we are able to bridge different approaches in East Asian Medicine and develop our insights and experience, we can contribute to its further growth.
However I am definitely not advising people to abandon their learned styles and blend everything in a new kind of model. We should be wary of every model as it becomes too elevated. Far more we should strive for an individual style developed by the skilled practitioner which will be a mélange of styles and approaches. Every style has its incredible beauty and value , and it is worth to improve one’s skills in such styles. Only when we are able to use our skills naturally and effortlessly we have truly obtained them. Toyohari and Engaging Vitality are both approaches which can greatly benefit the individual practitioner. Both styles have unique features which could be integrated in one’s personal approach. If we are able to optimize our understanding of core concepts in these approaches and integrate those in our clinical practice, we will be able to benefit people even more with our acupuncture. Oriental Medicine has always developed itself by clinical experience and inventive spirits, rooted in tradition but always open for new approaches. All we have to do is to continue this path.
Further Reading :
Efficacy Born of Disposition (Shi 勢), A Broad Perspective on Treatment Strategy in Acupuncture Therapy – Charles Chace/Manuel Rodriguez Cuadras, upcoming
Restoring Order in Health and Chinese Medicine, Stephen Birch, Miguel Angel Cabrer Mir, Manuel Rodiguez Cuadras, La Liebre de Marzo 2015
The Propensity of Things , Francois Julien , Zone Books 1995
Hiding the World in the World – Uneven Discourses on the Zhuangzi – edited by Scott Cook, Suny Press (2003)
The state of the Practitioner, some reflections on crucial points in regard to the mental and physical state of the practitioner. Felix de Haas , upcoming
The Complete Works of Chuang Tzu, Burton Watson, Columbia University Press; First Edition edition (April 15, 1968)
Wandering on the Way: Early Taoist Tales and Parables of Chuang Tzu, Victor Mair, Univ of Hawaii Pr (January 1998)
Zhuangzi: Text and Context, Livia Kohn, Three Pines Press; First Three Pines edition (January 1, 2014)
An Exposition on the Eight Extraordinary Vessels: Acupuncture, Alchemy, and Herbal Medicine, Charles Chace/Miki Shima. Eastland Press (5 Mar. 2010)